Comparative Efficacy of bDMARDs and tsDMARDs for the Treatment of Rheumatoid arthritis: A Systematic Review and Network Meta-Analysis

To compare the relative clinical efficacy of biologic disease-modifying anti-rheumatic drugs (bDMARDs) and targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs) (adalimumab, infliximab, certolizumab pegol, golimumab, tocilizumab, sarilumab, tofacitinib, baricitinib, upadacitinib, peficitinib, filgotinib, abatacept, anakinra, rituximab) in patients with rheumatoid arthritis (RA) who had been treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) without adequate response by network meta-analysis. The computer comprehensively searched PubMed, Embase, Cochrane Library, Web of Science, China Knowledge Network (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang, and VIP databases for randomized controlled trials (RCTs) of bDMARDs and tsDMARDs in the treatment of RA. The search time limit was set from the establishment of the databases to February 18, 2023. The quality assessment of the included studies was performed using the Cochrane Collaboration’s tool, and the R software (version 4.1.3) calling the gemtc package (version 1.0-1) in conjunction with JAGS software was for data analysis. Efficacy outcomes included American College of Rheumatology 20%, 50%, 70% response (ACR20, ACR50, ACR70). The included 68 RCTs, totaling 32356 patients with RA were analyzed. There were 68, 64 and 63 studies reported the outcomes of ACR20, ACR50, and ACR70 respectively. The result showed that fifteen drugs all had significant difference compared with placebo. According to the SUCRA values, certolizumab pegol had the highest probability of becoming the best intervention in ACR20 and ACR50, and etanercept was ranked first in ACR70, followed by certolizumab pegol. In conclusion, bDMARDs and tsDMARDs were all effective in improving signs and symptoms in RA patients who had been treated with csDMARDs without adequate response. Certolizumab combined with csDMARDs had better performance on efficacy compared with other interventions.